Review Article

Clinical and Molecular Characteristics Associated with Survival in Advanced Melanoma Treated with Checkpoint Inhibitors

Table 1

Primary end-point of included studies.

Study Name (Clinical trials identifier)Study PopulationTreatment Arms and DosagesSurvival Results

CheckMate 037
NCT01721746
Advanced melanoma (Stage IIIc and IV) who have progressed on Ipilimumab and BRAF therapyArm 1: Nivolumab 3 mg/kg every 2 weeks treated until progression.
Arm 2: Investigator choice, which included dacarbazine 1000 mg/m2 every 3 weeks or carboplatin area under curve 6 plus paclitaxel 175 mg/m2 (Comparison)
OS
Arm 1: 16 months 
Arm 2: 14 months 
HR 0.95 (CI 0.73-1.24) 
PFS
Arm 1: 3.1 months 
Arm 2: 3.7 months 
HR 1.0 (CI 0.78-1.436)

CheckMate 066
NCT01721772
Advanced melanoma 
(stage IIIc and IV) untreated without BRAF Mutation
Arm 1: Nivolumab 3 mg/kg every 2 weeks treated until progression.
Arm 2: Investigator choice, which included dacarbazine 1000 mg/m2 every 3 weeks or carboplatin area under curve 6 plus paclitaxel 175 mg/m2 (Comparison)
OS at 1 year
Arm 1: 72.9% (CI 65.5-78.9) 
Arm 2: 42.1% (CI 33-50.9) 
PFS
Arm 1: 5.1 months 
Arm 2: 2.2 months 
HR 0.43 (CI 0.34-0.56) 
p<0.001

CheckMate 067
NCT01844505
Untreated stage III (unresectable) or Stage IV melanoma, With known BRAF V600 Mutation status, And with ECOG of 0 or 1Arm 1: Nivolumab 1 mg/kg + ipilimumab 3 mg/kg every 3 weeks for four doses followed by nivolumab 3 mg/kg every 2 weeks + placebo 
Arm 2: Nivolumab 3 mg/kg every 2 weeks + Placebo 
Arm 3: Ipilimumab 3 mg/kg every 3 weeks + placebo (Comparison)
OS at 3 years
Arm 1: 58 % 
Arm 2: 52 % 
Arm 3: 34% 
PFS
Arm 1: 11.5 months 
HR 0.43 (CI 0.35-0.52) 
Arm 2: 6.9 months 
Arm 3: 2.9 months 
Arm 2 vs 3 HR 0.55 (CI 0.64-0.96)

CheckMate 069
NCT01927419
Untreated stage III (unresectable) or stage IV melanoma, with BRAF wild type, ECOG of 0 or 1Arm 1: Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks for four doses followed by nivolumab 3 mg/kg every 2 weeks plus placebo 
Arm 2: Ipilimumab 3 mg/kg every 3 week (Comparison)
OS 2-year follow-up data
Arm 1: 63·8% (CI 53·3–72·6) 
Arm 2: 53·6% (CI 38·1–66·8) 
HR 0·74, 95% (CI 0·43–1·26) 
p=0·26 
PFS at 2 years
Arm 1: Not reached 
Arm 2: 3 months 
HR 0.36 (CI 0.22-0.56) p <0.0001

KEYNOTE 006
NCT01866319
Unresectable Stage III Or IV advanced Melanoma (excluding Ocular melanoma) and up to one previous systemic chemotherapy (excluding anti CTLA- 4, PD-1 or PD-L1)Arm 1: Pembrolizumab 10 mg/kg every 2 weeks 
Arm 2: Pembrolizumab 10 mg /kg every 3 weeks 
Arm 3: IV ipilimumab 3 mg/kg every 3 weeks (Comparison)
OS
Arm 1: NR (22.1-NR) HR 
0.68 (0.53-0.87) 
p<0.0009 
Arm 2: NR (23.5-NR) HR 
0.68 (053-0.86) 
p <0.0008 
Arm 3: 16 months (13.5-22) 
PFS
Arm 1: 5.6 months HR 0.61 (0.5-075) 
Arm 2: 4.1 months HR 0.61 (0.5-0.75) 
Arm 3: 2.8 months HR NA 
p<0.0001

KEYNOTE 002
NCT0170428
Unresectable stage III or stage IV melanoma, Confirmed Disease progression on previous BRAF, MEK or CTLA-4 inhibitor therapy. ECOG 0 or 1Arm 1: 180: Pembrolizumab 2 mg/kg 
Arm 2: 181: Pembrolizumab 10 mg/kg iv every 3 Weeks 
Arm 3: Investigator choice chemotherapy (paclitaxel plus carboplatin, paclitaxel, carboplatin, dacarbazine) (Comparison)
OS: NA
PFS at 6 months
Arm 1: 34% HR 0.57 (0.45-0.73) p<0.0001 
Arm 2: 38% HR 0.5 (0.39-0.64) p <0.0001 
Arm 3: 16% in comparison to above arms